Preferred Maketing Associates (PMA)
Monday - Thursday:
8 am - 4:45 pm
Friday:
8 am - 12:30 pm
Supplies
            2019 Nebraska Application  (711 kb)
            2019 Nebraska Change Form  (1241 kb)
      Please complete for all Marketplace enrollments
            2019 Medica AOR Form  (126 kb)
            Premium Payment Options Form  (190 kb)
      For off-market cancellations only
            Policy Termination Form  (265 kb)
            2019 NE Off-Market Product Brochure  (4092 kb)
            2019 NE Marketplace Product Brochure  (9290 kb)
            2019 NE CHI & Elevate Plans Comparison  (145 kb)
            2019 NE-IA Insure Plans Comparison  (81 kb)
            2019 IA Marketplace Product Brochure  (8362 kb)
            2019 IA Inspire, CHI, & Elevate Plans Comparison  (122 kb)
            2019 KS Marketplace Product Brochure  (6988 kb)
            2019 KS Connect Plans Comparison  (114 kb)
            2019 KS & MO Select Plans Comparison  (143 kb)
            2019 MO Marketplace Product Brochure  (8753 kb)
            2019 OK Marketplace Product Brochure  (11608 kb)
            2019 OK Harmony & Medica Quest Plans Comparison  (149 kb)
            2018 Nebraska Application  (612 kb)
            2018 Nebraska Change Application  (464 kb)
            Payment Options Form  (190 kb)
      Note: Gold Copay Plus is not available to individuals and families living in Buffalo, Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Fillmore, Hall, Johnson, Lancaster, Nance, Nemaha, Nuckolls, Otoe, Pawnee, Saline, Sarpy, Saunders, Seward, Thayer or Washington county.
            2018 NE Medica Insure Rate Guide  (758 kb)
            2018 NE Medica with CHI Rate Guide  (693 kb)
            2018 IA Medica Insure Rate Guide  (920 kb)
            2018 IA Medica with CHI Rate Guide  (580 kb)
            2018 IA Inspire by Medica Rate Guide  (860 kb)
            2018 NE Product Brochure  (736 kb)
            2018 NE Plan Comparison  (173 kb)
            2018 IA Product Brochure  (1617 kb)
            2018 IA Plan Comparison  (321 kb)
            2018 KS Medica Connect Rate Guide  (836 kb)
            2018 KS Select by Medica Rate Guide  (587 kb)
            2018 KS Product Brochure  (895 kb)
            2018 KS Plan Comparison  (170 kb)
            Continuity of Care Request  (662 kb)
            Medical Claim Form  (1069 kb)
            Prescription Claim Form  (103 kb)
            Health Advocate Flyer  (417 kb)
            Nurse Line Flyer  (712 kb)
            Healthy Living Flyer  (559 kb)
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